Articulating clip applier cartridge

ABSTRACT

An end effector is provided and includes a distal housing portion and a proximal housing portion interconnected to one another by a knuckle portion, wherein the knuckle portion permits rotation of the distal housing portion relative thereto and articulation of the distal housing portion relative to the proximal housing portion; a jaw assembly supported in the distal end of the distal housing portion, the jaw assembly including a first jaw and a second jaw movable between a spaced apart and an approximated position; and a plurality of fasteners loaded within the distal housing portion, each of the plurality of fasteners defining a fastener axis extending in a direction substantially parallel to a pair of legs thereof, each of the plurality of fasteners being arranged within the base portion such that the fastener axis is disposed at an angle with respect to a longitudinal axis of the distal housing portion.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.13/771,472 filed Feb. 20, 2013, now U.S. Pat. No. 8,961,542, which is acontinuation of U.S. patent application Ser. No. 13/151,372 filed Jun.2, 2011, now U.S. Pat No. 8,403,946, which claims benefit of U.S.Provisional Application No. 61/368,463 filed Jul. 28, 2010, and thedisclosures of each of the above-identified applications are herebyincorporated by reference in their entirety.

BACKGROUND

1. Technical Field

The present disclosure relates to surgical clip appliers and, moreparticularly, to a novel articulating endoscopic surgical fastenerapplier cartridge.

2. Background of Related Art

Endoscopic staplers and clip appliers are known in the art and are usedfor a number of distinct and useful surgical procedures. In the case ofa laparoscopic surgical procedure, access to the interior of an abdomenis achieved through narrow tubes or cannulas inserted through a smallentrance incision in the skin. Minimally invasive procedures performedelsewhere in the body are often generally referred to as endoscopicprocedures. Typically, a tube or cannula device is extended into thepatient's body through the entrance incision to provide an access port.The port allows the surgeon to insert a number of different surgicalinstruments therethrough using a trocar and for performing surgicalprocedures far removed from the incision.

During a majority of these procedures, the surgeon must often terminatethe flow of blood or another fluid through one or more vessels. Thesurgeon will often apply a surgical clip to a blood vessel or anotherduct to prevent the flow of body fluids therethrough during theprocedure. An endoscopic clip applier is known in the art for applying asingle clip during an entry to the body cavity. Such single clipappliers are typically fabricated from a biocompatible material and areusually compressed over a vessel. Once applied to the vessel, thecompressed clip terminates the flow of fluid therethrough.

Endoscopic clip appliers that are able to apply multiple clips inendoscopic or laparoscopic procedures during a single entry into thebody cavity are described in commonly assigned U.S. Pat. Nos. 5,084,057and 5,100,420 to Green et al., which are both incorporated by referencein their entirety. Another multiple endoscopic clip applier is disclosedin commonly assigned U.S. Pat. No. 5,607,436 to Pratt et al., thecontents of which is also hereby incorporated by reference herein in itsentirety. These devices are typically, though not necessarily, usedduring a single surgical procedure. U.S. patent application Ser. No.08/515,341 now U.S. Pat. No. 5,695,502 to Pier et al., the disclosure ofwhich is hereby incorporated by reference herein, discloses aresterilizable surgical clip applier. The clip applier advances andforms multiple clips during a single insertion into the body cavity.This resterilizable clip applier is configured to receive and cooperatewith an interchangeable clip magazine to advance and form multiple clipsduring a single entry into a body cavity. One significant design goal isthat the surgical clip be loaded between the jaws without anycompression of the clip from the loading procedure.

Endoscopic or laparoscopic procedures are often performed remotely fromthe incision. Consequently, application of clips may be complicated by areduced field of view or reduced tactile feedback for the user at theproximal end of the device. It is therefore desirable to improve theoperation of the instrument by providing an instrument that is capableof articulating.

SUMMARY

The present disclosure relates to surgical clip appliers.

According to an aspect of the present disclosure, a surgical apparatusfor application of surgical clips to body tissue is provided andincludes a housing, a drive assembly, a shaft assembly, and a trigger.The shaft assembly extends distally from the housing. The drive assemblyis at least partially positioned within the housing. The trigger isoperatively connected to the drive assembly.

The shaft assembly has a first tubular member and a second tubularmember located distally from the first tubular member. The first tubularmember defines a longitudinal axis. The first tubular member and thesecond tubular member are pivotally connected through a common pivotaxis. The pivot axis is perpendicular to the longitudinal axis. Thedrive assembly may include a flexible cable that transfers both atranslational force and a rotational force from inside of the housinginto the second tubular member.

An articulation mechanism operatively connects the first tubular memberand the second tubular member. The articulation mechanism includes agear rack, at least one gear and a gear segment. The gear rack has aplurality of teeth longitudinally placed thereon and is located withinthe first tubular member. The at least one gear is operatively connectedwith the gear rack within the first tubular member. The gear segmentextends proximally from the second tubular member and is operativelyconnected with the at least one gear. The gear segment is fixed withrespect to the second tubular member. The articulation mechanism pivotsthe second tubular member about the pivot axis at an angle of up to 90°from the longitudinal axis. The articulating mechanism may include acontrol knob that is rotatable to pivot the second tubular member.

The second tubular member may include a jaw assembly and a clipcartridge containing a plurality of fasteners disposed therein.

The surgical clip applying apparatus may include a rotation mechanism.The rotation mechanism is operatively connected with and provides arotational force to the jaw assembly. The rotation mechanism may includea dial and a band. The band is located about a proximal portion of thedrive assembly. The dial defines an internal passage and an innersurface. The band defines a contoured outer surface that receives andtransmits a rotational force from the inner surface of the dial to thedrive assembly. The dial is slidably coupled with the band.

The second tubular member may include two substantially parallel gearsegments.

In another embodiment, a surgical apparatus for application of surgicalclips to body tissue is provided and includes a housing, a driveassembly, a shaft assembly, and a trigger. The shaft assembly extendsdistally from the housing.

The shaft assembly has a first tubular member and a second tubularmember located distally from the first tubular member. The first tubularmember defines a first longitudinal axis, around which the first tubularmember may be rotated. The first tubular member and the second tubularmember are pivotally connected through a common pivot axis.

The second tubular member defines a second longitudinal axis. A distalportion of the second tubular member is rotatable about the secondlongitudinal axis. The second tubular member includes a geared segmentextending proximally from a proximal portion thereof.

The drive assembly is at least partially positioned within the housingand extends through the first tubular member and partially into thesecond tubular member. The drive assembly may include a flexible cableto transfer both a translational force and a rotational force frominside of the housing into the second tubular member. The trigger isoperatively connected to the drive assembly.

A rack extends along a portion of the longitudinal axis. The rack islocated within the first tubular member and reciprocates along the firstlongitudinal axis. The rack is operatively connected with the gearedsegment.

The surgical clip applying apparatus may include an articulationmechanism that provides a pivotal force to pivot the second tubularmember about the pivot axis at an angle of up to 90° from the firstlongitudinal axis. The articulating mechanism includes a control knobbeing rotatable to retract the rack proximally and to extend the rackdistally.

The surgical clip applying apparatus may further include a rotationmechanism. The rotation mechanism is operatively connected with thedrive assembly to provide a rotational force to the distal portion ofthe second tubular member. The rotation mechanism includes a dial and aband located about a proximal portion of the drive assembly. The dialdefines an internal passage and an inner surface. The band defines acontoured outer surface that is able receive and transmit a rotationalforce from the inner surface of the dial to the proximal portion of thedrive assembly. The dial is slidably coupled with the band.

The second tubular member may include a jaw assembly and a clipcartridge containing a plurality of clips disposed therein. The rotationmechanism may be connected with and provide a rotational force to thejaw assembly.

According to another aspect of the present disclosure, an end effectorfor operative connection to a surgical handle assembly including anaxially reciprocatable drive assembly having a flexible drive cableoperatively connected to the end effector is provided. The end effectorincludes a distal housing portion defining a proximal end, a distal end,and a longitudinal axis; a knuckle portion extending proximally from theproximal end of the distal housing portion, the knuckle portion beingbifurcated into a first geared portion and a second geared portion, thedistal housing portion being rotatably mounted to the knuckle portion toallow the distal housing portion to rotate about the longitudinal axiswith respect to the knuckle portion; a jaw assembly extending distallyfrom the base portion, the jaw assembly including a first jaw and asecond jaw movable between a spaced apart position and an approximatedposition; a plurality of surgical clips loaded in the housing in apartially stacked fashion; and a jaw closure mechanism disposed in thedistal housing portion and operatively associated with the jaw assemblyand the plurality of surgical clips. A distal end of the flexible drivecable is connected to the jaw closure mechanism so as to transmit anoperative force to the jaw closure mechanism when the longitudinal axisof the distal housing portion is either axially aligned or angled withrespect to a longitudinal axis of the surgical handle. The jaw closuremechanism feeds a clip into the jaw assembly and forms the fed clip upona single complete stroke of the flexible drive cable.

The end effector may further include a proximal housing pivotablyconnected to the knuckle portion; and a gear train supported in theproximal housing. A distal-most gear of the gear train may beoperatively engaged with the first geared portion and the second gearedportion of the knuckle portion.

The end effector may further include a rack slidably supported in theproximal housing, wherein the rack defines at least one axial row ofgear teeth, and wherein the axial row of gear teeth is engaged with aproximal-most gear of the gear train.

In use, axial displacement of the rack relative to the cover results inarticulation of the distal housing portion relative to the proximalhousing portion.

According to a further aspect of the present disclosure, an end effectorfor application of surgical clips to body tissue is provided. The endeffector includes a portion defining a proximal end, a distal end, and alongitudinal axis; a knuckle portion extending proximally from theproximal end of the base portion, the knuckle portion being bifurcatedinto a first geared portion and a second geared portion, the baseportion being rotatably mounted to the knuckle portion to allow the baseportion to rotate about the longitudinal axis with respect to theknuckle portion; a jaw assembly extending distally from the baseportion, the jaw assembly including a first jaw and a second jaw movablebetween a spaced apart position and an approximated position; and aplurality of fasteners located within the base portion, each of theplurality of fasteners having a pair of legs extending from a backspan,each of the plurality of fasteners defining a fastener axis extending ina direction substantially parallel to the pair of legs, each of theplurality of fasteners being arranged within the base portion to form anangle between the fastener axis and the longitudinal axis, each of theplurality of fasteners being located adjacent to another of theplurality of fasteners to form a stack.

The knuckle may include a pivot structure that defines a pivot axis.

The end effector may further include a jaw closure mechanism operativelyconnected to the jaw assembly, the jaw closure mechanism providing anapproximating force to the first jaw and the second jaw.

The knuckle portion may include a plurality of teeth.

The plurality of fasteners may be stacked in a non-colinear positionwith respect to the second longitudinal axis.

The first jaw and the second jaw may be angled with respect to thelongitudinal axis.

The legs of the plurality of fasteners may be disposed in asubstantially parallel orientation to the first jaw and the second jaw.

The fasteners may have a U-shape or a V-shape. The stack of fastenersmay extend parallel to the longitudinal axis.

The end effector may further include a proximal housing portionconnected to knuckle portion such that base portion is pivotableoff-axis with respect to the cover. The proximal housing portion maysupport a gear train in a distal region thereof, and wherein adistal-most gear of the gear train may be operatively engaged with thefirst geared portion and the second geared portion of the knuckleportion. The end effector may further include a rack slidably supportedin a proximal region of the proximal housing portion, wherein the rackdefines at least one axial row of gear teeth, and wherein the axial rowof gear teeth is engaged with a proximal-most gear of the gear train.

In use, axial displacement of the rack relative to the proximal housingportion may result in articulation of the base portion relative to theproximal housing portion.

According to yet another aspect of the present disclosure, an endeffector for operative connection to a surgical handle assemblyincluding an axially reciprocatable drive assembly having a flexibledrive cable operatively connected to the end effector is provided. Theend effector includes a distal housing portion defining a proximal end,a distal end and a longitudinal axis; a proximal housing portiondefining a proximal end, a distal end and a longitudinal axis; a knuckleportion interconnecting the proximal end of the distal housing portionand the distal end of the proximal housing portion, wherein the knuckleportion permits rotation of the distal housing portion relative theretoand articulation of the distal housing portion relative to the proximalhousing portion; a jaw assembly supported in the distal end of thedistal housing portion, the jaw assembly including a first jaw and asecond jaw movable between a spaced apart position and an approximatedposition; and a plurality of fasteners loaded within the distal housingportion, each of the plurality of fasteners having a pair of legsextending from a backspan, each of the plurality of fasteners defining afastener axis extending in a direction substantially parallel to thepair of legs, each of the plurality of fasteners being arranged withinthe base portion such that the fastener axis is disposed at an anglewith respect to the longitudinal axis of the distal housing portion, andwherein the plurality of fasteners are arranged in a stack.

The end effector may further include a jaw closure mechanism operativelyconnected to the jaw assembly, wherein the jaw closure mechanismprovides an approximating force to the first jaw and the second jaw upona proximal movement thereof relative to the first jaw and the secondjaw.

The jaw closure mechanism may include a cam plate axially slidablysupported in the distal housing portion, wherein the cam plate includesa camming aperture formed therein, wherein the camming aperture has asubstantially “V” shaped profile, and wherein each of first jaw andsecond jaw includes a post extending therefrom and into the cammingaperture of the cam plate. In use, movement of the cam plate proximallyrelative to the first jaw and second jaw engages an edge of the cammingaperture against the nubs of the first jaw and the second jaw toapproximate the first jaw and the second jaw.

The cam plate may include a protrusion extending distally into thecamming aperture; wherein movement of the cam plate distally relative tothe first jaw and second jaw engages the protrusion of the cammingaperture between the nubs of the first jaw and the second jaw toseparate the first jaw and the second jaw.

The flexible drive cable may extend between the distal housing portionand the proximal housing portion, and across the knuckle portion.

A proximal end of the drive cable may be connected to a drive assemblyand a distal end of the drive cable may be connected to a block memberslidably supported in the base portion, wherein distal movement of thedrive cable results in distal movement of the block member to distallyadvance a feed bar and load a fastener into the jaw assembly.

The end effector may further include a cam plate axially slidablysupported in the base portion; wherein the block member includes afinger extending into a proximal axially extending slot provided in thecam plate; wherein the cam plate includes a camming aperture formedtherein; wherein the camming aperture has a substantially “V” shapedprofile, and wherein each of first jaw and second jaw includes a postextending therefrom and into the camming aperture of the cam plate. Inuse, distal movement of the block member may result in distal movementof the cam plate and proximal movement of the block member results inproximal movement of the cam plate. Additionally, in use, movement ofthe cam plate proximally relative to the first jaw and second jawengages an edge of the camming aperture against the nubs of the firstjaw and the second jaw to approximate the first jaw and the second jaw.

The cam plate may include a protrusion extending distally into thecamming aperture, wherein movement of the cam plate distally relative tothe first jaw and second jaw engages the protrusion of the cammingaperture between the nubs of the first jaw and the second jaw toseparate the first jaw and the second jaw.

The cam plate may be biased to a distal position.

The end effector may further include a clip follower disposed proximallyof the plurality of fasteners, wherein the clip follower is biased in adistal direction to urge the plurality of fasteners distally.

The knuckle portion may be bifurcated into a first geared portion and asecond geared portion.

The proximal housing portion may support a gear train in a distal regionthereof, and wherein a distal-most gear of the gear train is operativelyengaged with the first geared portion and the second geared portion ofthe knuckle portion.

The end effector may further include a rack slidably supported in aproximal region of the proximal housing portion, wherein the rackdefines at least one axial row of gear teeth, and wherein the axial rowof gear teeth is engaged with a proximal-most gear of the gear train.

In use, axial displacement of the rack relative to the proximal housingportion results in articulation of the distal housing portion relativeto the proximal housing portion such that the longitudinal axis of thedistal housing portion is angled with respect to the longitudinal axisof the proximal housing portion.

BRIEF DESCRIPTION OF THE DRAWINGS

The present clip applier will be more fully appreciated as the samebecomes better understood from the following detailed description whenconsidered in connection with the following drawings, in which:

FIG. 1 is a front, perspective view of a surgical clip applier accordingto an embodiment of the present disclosure;

FIG. 2 is a front, perspective view of the indicated area of detail ofFIG. 1, illustrating a clip cartridge of the clip applier of FIG. 1;

FIG. 3 is a left-side, elevational view of the clip cartridge of thesurgical clip applier of FIGS. 1 and 2;

FIG. 4 is a top, plan view of the clip cartridge of the surgical clipapplier of FIGS. 1-3;

FIG. 5 is a perspective view of the surgical clip applier of FIGS. 1-4illustrating an articulation of the clip cartridge;

FIG. 5A is a cross-sectional side view of a body of the surgical clipapplier of FIGS. 1-5, as taken through 5A-5A of FIG. 5;

FIG. 5B is a cross-sectional view of the body of the surgical clipapplier of FIGS. 1-5A, as taken through 5B-5B of FIG. 5A;

FIG. 6 is an exploded view of a shaft assembly of the surgical clipapplier of FIG. 5;

FIG. 7 is an enlarged perspective view of an articulation plunger of theshaft assembly of FIG. 6;

FIG. 8 is an enlarged exploded view of an articulation screw of theshaft assembly of FIG. 6;

FIG. 9 is an enlarged view of the articulation screw placed about theproximal end of the articulation plunger of the shaft assembly of FIG.6;

FIG. 10 is an enlarged perspective view of a distal portion of a shaftof the shaft assembly of FIG. 6, with the drive shaft extendingtherethrough;

FIG. 11 is an enlarged perspective view of a rack coupled to the shaftof the shaft assembly of FIG. 6;

FIG. 12 is an exploded view of a distal end of a first tubular portionof the shaft assembly of the surgical clip applier as indicated by thedetail of FIG. 6;

FIG. 12A is an enlarged perspective view of a first gear of the shaftassembly of the surgical clip applier as indicated by the detail of FIG.12;

FIG. 12B is an enlarged perspective view of a second gear of the shaftassembly of the surgical clip applier as indicated by the detail of FIG.12;

FIG. 12C is an enlarged perspective view of a third gear of the shaftassembly of the surgical clip applier as indicated by the detail of FIG.12;

FIG. 13 is a front, perspective view of the distal end of a firsttubular portion of the shaft assembly of the surgical clip applier asindicated by the detail of FIG. 6;

FIG. 14 is a front, perspective view of the distal end of a firsttubular portion of the shaft assembly of the surgical clip applier asindicated by the detail of FIG. 6, with a right side end cover and theouter tube removed;

FIG. 15 is a front, perspective view of the distal end of a firsttubular portion of the shaft assembly of the surgical clip applier asindicated by the detail of FIG. 6, with a right side end cover, theouter tube, the first gear, the second gear, and the third gear removed;

FIG. 16 is a longitudinal cross-sectional view of the distal end of afirst tubular portion of the shaft assembly of the surgical clip applieras indicated by the detail of FIG. 6, showing the connection between therack, the first gear, the second gear, the third gear, and aarticulation knuckle of the second tubular portion;

FIG. 17 is a further longitudinal cross-sectional view of the distal endof a first tubular portion of the shaft assembly of the surgical clipapplier as indicated by the detail of FIG. 6, showing the connectionbetween the rack, the first gear, the second gear, the third gear, andthe articulation knuckle of the second tubular portion in an articulatedposition;

FIG. 18 is an enlarged longitudinal cross-sectional view of theindicated area of detail of FIG. 17, illustrating the distal end of afirst tubular portion and the second tubular portion in an articulatedposition;

FIG. 19 is a longitudinal cross-sectional view of the shaft assembly ofFIG. 6, as taken through 19-19 of FIG. 1;

FIG. 20 is an enlarged longitudinal cross-sectional view of theindicated area of detail of FIG. 19 of the shaft assembly;

FIG. 21 is an enlarged cross-sectional view of the proximal portion ofthe shaft assembly as illustrated in FIG. 20;

FIG. 22 is an enlarged cross-sectional view of the indicated area ofdetail of FIG. 20 of the shaft assembly as detailed in FIG. 20;

FIG. 23 is an enlarged cross-sectional view of the indicated area ofdetail of FIG. 22 of the shaft assembly;

FIG. 24 is an enlarged cross-sectional view of the indicated area ofdetail of FIG. 19 of the shaft assembly;

FIG. 25 is an enlarged cross-sectional view of the indicated area ofdetail of FIG. 24 of the proximal portion of the second tubular portionas illustrated in FIG. 24;

FIG. 26 is an enlarged cross-sectional view of the indicated area ofdetail of FIG. 25 illustrating a distal end of a clip pusher of thesecond tubular portion;

FIG. 27 is a perspective view of the clip cartridge of the secondtubular portion as indicated in FIG. 6, with parts separated;

FIG. 27A is a front, plan view of a clip used in the cartridge of thesurgical clip applier of FIG. 27;

FIG. 28 is a perspective view of a housing of the clip cartridge of FIG.27;

FIG. 29 is a perspective view of a camming plate of the clip cartridgeof FIG. 27;

FIG. 30 is a perspective view of a jaw structure of the clip cartridgeof FIG. 27;

FIG. 31 is a perspective view of a block member of the clip cartridge ofFIG. 27;

FIG. 32 is a perspective view of a clip pusher of the clip cartridge ofFIG. 27;

FIG. 33 is a perspective view of a clip follower of the clip cartridgeof FIG. 27;

FIG. 34 is a perspective view of a clip carrier of the clip cartridge ofFIG. 27;

FIG. 35 is a bottom perspective view of a cover of the clip cartridge ofFIG. 27;

FIG. 36 is a perspective view of the housing coupled to the knuckle ofthe clip cartridge;

FIG. 37 is a perspective view of the housing of FIG. 36 with the jawstructure removed therefrom;

FIG. 38 is a perspective view of the housing of FIG. 36 with the jawstructure and the camming plate removed therefrom;

FIG. 39 is a perspective view of the housing of FIG. 36 including thedistal member and the clip pusher in position;

FIG. 40 is a perspective view of the housing of FIG. 39 with theaddition of the clip carrier and clip follower thereon;

FIG. 41 is an enlarged detail view of the clip carrier and clip pusheras indicated in FIG. 40;

FIG. 42 is a perspective view of the housing of FIG. 40 with theaddition of a clip stack thereon;

FIG. 43 is an enlarged detail view of the clip stack as indicated inFIG. 40;

FIG. 44 is an longitudinal cross-sectional view of the clip cartridge,illustrating a clip being loaded during a first stage of operation;

FIG. 45 is an enlarged longitudinal cross-sectional view of the clipcartridge as indicated in FIG. 44, illustrating the clip being loadedduring the first stage of operation;

FIG. 46 is an longitudinal cross-sectional view of the clip cartridge,illustrating a complete advancement of the clip pusher during the firststage of operation;

FIG. 47 is an enlarged longitudinal cross-sectional view of the clipcartridge as indicated in FIG. 46, illustrating a return of the clippusher during a second stage of operation;

FIG. 48 is an longitudinal cross-sectional view of the clip cartridge,illustrating the forming of the loaded clip during a third stage ofoperation;

FIG. 49 is a perspective view of the jaw structure and the camming plateduring the first and second stages of operation, illustrating aseparator forcing the jaws apart;

FIG. 50 is a top plan view of the jaw structure and the camming plateduring the first and second stages of operation, illustrating theseparator forcing the jaws apart;

FIG. 51 is a top plan view of the jaw structure and the camming plateduring the third stage of operation, illustrating the formation of theloaded clip about a vessel; and

FIG. 52 is a perspective view of the clip formed about and sealing avessel.

Other features of the present disclosure will become apparent from thefollowing detailed description, taken in conjunction with theaccompanying drawings, which illustrate, by way of example, theprinciples of the present disclosure.

DETAILED DESCRIPTION OF EMBODIMENTS

Embodiments of surgical clip appliers in accordance with the presentdisclosure will now be described in detail with reference to the drawingfigures wherein like reference numerals identify similar or identicalstructural elements. As shown in the drawings and described throughoutthe following description, as is traditional when referring to relativepositioning on a surgical instrument, the term “proximal” refers to theend of the apparatus which is closer to the user and the term “distal”refers to the end of the apparatus which is further away from the user.

With reference to FIG. 1, reference numeral 100 designates an embodimentof the presently disclosed surgical clip applier. In the interest ofbrevity, the present disclosure focuses on an articulation mechanism anda clip applying end mechanism of surgical clip applier 100. U.S. Pat.No. 7,637,917, filed on Oct. 7, 2005, describes in detail the structureand operation of a surgical clip applier that may incorporate thepresently disclosed articulation mechanism and a clip applying endmechanism, the entire content of which is incorporated herein byreference.

Clip applier 100 includes a handle assembly 200 and an articulatingendoscopic portion or a shaft assembly 300 extending distally fromhandle assembly 200. Referring now to FIGS. 5, 5A, 5B-8, handle assembly200 of surgical clip applier 100 is shown. Handle assembly 200 includesa housing 202 having a first or right side half-section 202 a and asecond or left side half-section 202 b. Handle assembly 200 includes atrigger 208 pivotably supported between right side half-section 202 aand left side half-section 202 b. Housing 202 of handle assembly 200 maybe formed of a suitable plastic material.

As seen in FIGS. 1-15, the shaft assembly 300 includes a first tubularmember 302 and a second tubular member or an end effector 500. The firsttubular member 302 defines a first longitudinal ‘X1’ axis and the endeffector 500 defines a second longitudinal ‘X2’ axis. The end effector500 is located distally from the first tubular member 302. The firsttubular member 302 and the end effector 500 are pivotally connected toeach other through a common pivot axis. The common pivot ‘Z’ axis issubstantially perpendicular to both the first longitudinal ‘X1’ axis andthe second longitudinal ‘X2’ axis. Shaft assembly 300 and the componentsthereof may be formed of suitable biocompatible materials, such as, forexample, stainless steel, titanium, plastics, and the like.

As seen in FIG. 5, the first tubular member 302 has a rotation mechanism304, and an articulation mechanism 320. The rotation mechanism 304allows the first tubular member 302 to rotate, with respect to housing202, about the first longitudinal ‘X1’ axis. The rotation mechanism 304includes a rotation knob 306 that is rotatably coupled to the housing202 and an outer tube 310. The rotation knob 306 is supported betweenthe housing half-sections 202 a, 202 b.

As seen in FIGS. 5 and 6, the outer tube 310 is at least partiallysupported by rotation knob 306, and has a proximal end 310 a and adistal end 310 b. The outer tube 310 defines a lumen 312, extendinglongitudinally therethrough, and a pair of openings 314, formed near theproximal end 310 a of the outer tube 310. With reference to FIGS. 20 and21, the rotation knob 306 has a pair of nubs 307 that extend into andinterface with the openings 314 of the outer tube 310. In use, as seenin FIG. 1, rotation of the rotation knob 306 causes the outer tube 310to rotate about the first longitudinal ‘X1’ axis and thus results in therotation of the entire shaft assembly 300.

As seen in FIG. 5A, clip applier 100 includes a drive assembly 220operatively connected to trigger 208. The drive assembly 220 is at leastpartially positioned within the housing 202 of handle assembly 200 andextends through the first tubular member 302 and at least partially intothe end effector 500. The drive assembly 220 is able to transfer both atranslational force and a rotational force into the end effector 500.

The trigger 208 is operatively connected to a link 210. Link 210 may beconnected to an electrical motor 212, which is connected with a drivemember 226. The drive member 226 is rotatably attached to the proximalend 222 a of the drive rod 222 via a coupling 230 that allows the driverod 222 to rotate with respect to the drive member 226.

The drive rod 222 may have a cylindrical shape and may extend at leastpartially along the first tubular member 302. With additional referenceto FIG. 44, drive assembly 220 includes a flexible drive cable 224mounted to the distal end 222 b of the drive rod 222. Drive cable 224extends distally from drive rod 222 and into the end effector 500. It isenvisioned that the drive cable 224 may have a cross-sectional shapethat is non-circular.

As seen in FIGS. 5-5B, clip applier 100 further includes a positioningmechanism 530. The positioning mechanism 530 is operatively connectedwith the drive assembly 220 to provide a rotational force to a distalportion or clip cartridge 550 of the end effector 500. As seen in FIG.5A, the positioning mechanism 530 includes a rotation knob 306, portionsof the drive rod 222, and portions of the drive cable 224.

The drive rod 222 includes a contoured outer surface or shaped band 232that is complimentary to an aperture 242 in the rotation knob 306. Theaperture 242 is sized slightly larger than the shaped band 232 of thedrive rod 222. The over sized aperture 242 allows for longitudinalmovement of the drive rod 222 through the aperture 242. The drive rod222 is able to freely rotate within the first tubular member 302, whichallows the drive rod 222 to receive and transmit a rotational force fromthe rotation knob 306 to the proximal portion of the drive assembly 220.

As seen in FIG. 5, clip applier 100 includes an articulation mechanism320 operatively connecting the first tubular member 302 with the endeffector 500. The articulation mechanism 320 provides a pivot force tothe end effector 500 to pivot the end effector 500 about the pivot axisat an angle of up to about 90° relative to the first longitudinal ‘X1’axis.

As seen in FIGS. 6 and 12-18, articulation assembly 320 includes anarticulation knob 322 rotatably supported by and projecting distallyfrom the rotation knob 306 (FIG. 5A). With reference to FIG. 21,articulation knob 322 has an internal thread 324 that is sized to acceptand compliment an external thread 332 (FIG. 8) of an articulation screw330. As seen in FIG. 8, articulation screw 330 includes a first or righthand half section 330 a and a second or left hand section 330 b. Eachsection 330 a, 330 b has a nub 334 projecting radially inward from aninner curved surface 336. Each nub 334 extends through a slot 316 (FIG.6) defined in the outer tube 310 and into a radial recess 342 of anarticulation plunger 340 (FIG. 7).

Articulation assembly 320 includes an articulation plunger 340 thatextends between a proximal end 340 a, located proximally of nubs 334 ofarticulation screw 330 and outer tube 310. Articulation plunger 340defines a lumen 346 sized to allow passage of the drive rod 222therethrough. The articulation plunger 340 terminates in a distal end340 b having a mushroom shaped head 344. The mushroom shaped head 344has a larger distal portion 344 b than proximal portion 344 a.

With reference to FIGS. 6-7 and 9-11, clip applier 100 includes a shaft350 defining a proximal portion 352 having a proximal end 350 a, adistal portion 354 having a distal end 350 b, and a center portion 350c. The shaft 350 is semi-cylindrical in shape to allow the drive rod 222to pass therealong, and extends longitudinally within the outer tube310. As shown in FIG. 4, the proximal end 350 a and the distal end 350 bof shaft 350 are curved in an opposite transverse direction than thecenter portion 350 c. Shaft 350 defines a distal aperture that separatesthe distal portion 354 from the center portion 350 c and a proximalaperture that separates the proximal portion 352 from the center portion350 c. The distal aperture of shaft 350 is sized and configured toaccept the distal portion 334 b of head 344 of the articulation plunger340 therein and the distal portion forms an arc that is sized andconfigured to loosely set about distal portion 344 b of head 344 of thearticulation plunger 340.

As seen in FIG. 11, the proximal portion 352 of the shaft 350 removablycouples the shaft 350 to a rack 360. A proximal end 362 a of the rack360 is formed in a mushroom shaped tail 362. The proximal end 362 a ofthe mushroom shaped tail 362 is larger than the distal end 362 b of themushroom shaped tail 362. The proximal aperture of the shaft 350 issized to accept the proximal end 362 b of the mushroom shaped tail 362therein. The proximal portion 352 of shaft 350 forms an arc that issized to set loosely about distal end 362 b of the mushroom shaped tail362 of the rack 360.

As seen in FIG. 11, rack 360 includes a cylindrical section 363 and aproximal end 362 b disposed immediately adjacent to cylindrical section363 and that is sized slightly smaller than an inner diameter of theouter tube 310. The cylindrical section 363 may have one or morerecesses 364 about the perimeter that are sized to accept an O-seal 382therein, as shown in FIG. 17. The O-seal 382 is deformable to fill thespace between the cylindrical section 363 of the rack 360 and the innerdiameter of the outer tube 310 to substantially seal the distal portionof the first tubular member 302.

As shown in FIG. 11, the rack 360 defines a central passageway 365 alongthe first longitudinal ‘X1’ axis sized to allow passage of the drivecable 226 therethrough. A distal portion 366 of the rack 360 has arectangular cross-sectional shape. With reference to FIGS. 12 and 14,the distal portion 366 is sized to fit through the longitudinal centerof a helical spring 380. The spring 380 has an outer diameter sized tobe slightly smaller than the cylindrical section 363 of the rack 360. Asa result, the spring is prevented from passing proximally beyond thecylindrical section 363 of the rack 360.

As shown in FIGS. 11 and 12, the distal portion 366 of rack 360 includesat least two protrusions 367 and a set of longitudinally aligned linearteeth 368. The two protrusions 367 extend outward in opposite directionsfrom the proximal portion 366 and are aligned and sized to be placedinto slots 391 defined in an inner surface 392 of an end cover 390. Asseen in FIG. 12, the end cover 390 has a right hand side cover 390 a anda left hand side cover 390 b. The outer proximal portion 393 of endcover 390 defines an outer diameter that is sized to enable the endcover 390 to be pressed into the distal end 310 b of the outer tube 310and establish an interference fit between the end cover 390 and theouter tube 310.

The inner surface 392 of the end cover 390 has a rectangular shape thatis sized to be slightly larger than the rectangular cross-section of therack 360 to allow at least partial longitudinal movement of the rack 360therein. A proximal end 394 a of the end cover 390 is sized to besmaller than the spring 380 to provide a biasing surface for the spring380. As seen in FIGS. 14 and 15, the spring 380 is interposed between adistal surface 363 a of the cylindrical portion 363 and the proximal end394 a of the end cover 390 to bias the rack 360 proximally.

As seen in FIGS. 12 and 16, the inner surface 392 of the end coversections 390 a, 390 b define a series of three circular recesses 396 a,396 b, and 396 c. Each of the three circular recesses 396 a, 396 b, and396 c are centered about an aperture 397 a, 397 b, and 397 c througheach of the end cover sections 392 a, 392 b.

As stated above, the rack 360 is located within the outer tube 310 andextends into the end cover 390. The rack 360 is configured toreciprocate along the first longitudinal ‘X1’ axis. A proximal positionand a distal position of the rack 360 is defined by the two protrusions367 that are located within respective slots 391 of end cover 390. Thetwo protrusions 367 of rack 360, acting against the proximal end 391 aof the slots 391, define the proximal-most position of the rack 360. Thetwo protrusions 367 of rack 360, acting against the distal end 391 b ofthe slots 391, define the distal-most position of the rack 360.

While rack 360 includes a pair of opposed longitudinally arranged teeth368 that engage respective gear sets and mating structure, only a singleset of teeth 368 of rack 360 and a single respective gear set and matingstructure will be described herein for the purpose of clarity. As shownin FIGS. 12-18, rack 360 has a pair of longitudinally arranged teeth 368on opposing sides of the distal portion 366. The longitudinally arrangedteeth 368 are defined by recesses 369 in the distal portion 366 thatform the distal portion 366 into an “I” beam, wherein the longitudinallyarranged teeth 368 are formed along an inside of flanges of the “I” beamthat extend in opposing directions. The longitudinally arranged teeth368 are in intimate contact with a first gear 420 supported in end cover390.

As seen in FIG. 12A, the first gear 420 defines a center aperture 421, acircular base 422, a first circular set of teeth 423, and a secondcircular set of teeth 424. The first circular set of teeth 423 issmaller in diameter than and stacked upon the second set of teeth 424.The circular base 422 forms a substantially similar outer diameter asthe second set of teeth 424. As seen in FIG. 12, a first pin 410 has ahead portion 410 a that is larger than the aperture 421 of first gear420, a body portion 410 b slightly smaller in diameter than the centeraperture 421, and a tail portion 410 c that is sized to allow the firstpin 410 to be press fit into the aperture 397 a in the cover 390. Aninterference fit between the tail portion 410 c and the cover 390retains the tail portion 410 c in the aperture 397 a and holds the firstgear 420 at least partially within the first recess 396 a of the endcover 390. The longitudinally arranged teeth 368 of the rack 360 and thefirst gear 420 are connected, such that longitudinal movement of therack 360 relative to first gear 420 results in a rotational movement ina first direction of the first gear 420.

The first gear 420 is operatively connected with a second gear 430 ofthe gear set. As seen in FIG. 12B, the second gear 430 defines a centeraperture 431, a raised base 432, and a circular set of teeth 433. Theraised base 432 is circular in cross-sectional shape and has asubstantially smaller outer diameter than the circular set of teeth 423.A second pin 411 has a head portion 411 a that is larger than theaperture 431, a body portion 411 b that is slightly smaller in diameterthan the center aperture 431, and a tail portion 411 c that is sized toallow the second pin 411 to be press fit into the aperture 397 b in thecover 390. An interference fit between the tail portion 411 c and thecover 390 retains the tail portion 411 c in the aperture 397 b and holdsthe second gear 430 at least partially within the second recess 396 b ofthe end cover 390. The second circular set of teeth 424 of the firstgear 420 is interconnected with the circular set of teeth 433 of thesecond gear 430, such that rotational movement of the first gear 420 ina first direction results in a rotational movement of the second gear430 in a second direction.

The second gear 430 is operatively connected with a third gear 440 ofthe gear set. As seen in FIG. 12c , the third gear 440 defines a centeraperture 441, a circular base 442, and a circular set of teeth 443. Thecircular base 442 forms a substantially similar outer diameter as thecircular set of teeth 443. The circular base 442 is substantially equalin height as both the raised base 432 of the second gear 430 and thecircular base 422 of the first gear 420. A third pin 412 has a headportion 412 a that is larger than the aperture 441, a body portion 412 bthat is slightly smaller in diameter than the center aperture 441, and atail portion 412 c that is sized to allow the third pin 412 to be pressfit into the aperture 397 c in the cover 390. An interference fitbetween the tail portion 412 c and the cover 390 retains the tailportion 412 c in the aperture 397 c and holds the third gear 440 atleast partially within the second recess 396 c of the end cover 390. Thecircular set of teeth 433 of the second gear 40 is interconnected withthe circular set of teeth 444 of the third gear 440, such thatrotational movement of the second gear 430 in the second directionresults in a rotational movement of the third gear 440 in the firstdirection.

Located distally of the third gear 440, each of the end cover sections392 a, 392 b defines a boss 398 extending radially inward from thedistal portion 395 b of the end cover sections 392 a, 392 b. The bosses398 capture and secure a cylindrical distal, portion 522 of the endeffector 500 to the first tubular member 302.

As seen in FIG. 12, cylindrical distal portion 522 of the end effector500 has a knuckle 510. The knuckle 510 includes a bifurcated proximalportion 514 and a cylindrical distal portion 522. The bifurcatedproximal portion 514 defines a pivoting aperture 511 that isperpendicular to both the first longitudinal ‘X1’ axis and the secondlongitudinal ‘X2’ axis. The pivoting aperture 511 defines the pivot ‘Z’axis. The pivoting aperture 511 is circular in cross-sectional shape andis sized to accept the bosses 398 therein. The size and alignment of thebosses 398 allow the end cover sections 392 a, 392 b to sandwich theknuckle 510 therebetween. As a result of the circular bosses 398projecting into the circular pivoting aperture 511, the end effector 510is able to pivot or swing about the ‘Z’ axis.

The bifurcated proximal portion 514 of knuckle 510 includes two gearsegments 516 a, 516 b that are integrally formed therewith and thatextend proximally about the proximal end 510 a of the knuckle 510. Eachgear segment 516 defines an arcuate set of teeth 517 that areoperatively connected with the third gear 440.

The knuckle 510 further defines a lumen 518 through the center thereof,and a circular channel 520 about the cylindrical distal portion 522. Thecircular channel 520 is located proximally from the distal end 510 b ofthe knuckle 510. The center lumen 518 is sized to allow at least partialpassage of the drive cable 224 therethrough and at least partially intoa clip cartridge 550 (FIGS. 24 and 27) of the end effector 500.

The operation of the articulation mechanism will now be discussed inreference to FIGS. 6-21. With specific reference to FIGS. 20 and 21,rotation of the articulation knob 322 (FIG. 5) with respect to therotation knob 306 and the outer tube 310 produces longitudinal movementof the articulation screw 330 by causing the internal thread 324 of thearticulation knob 322 to react against the external thread 332 of thearticulation screw 330. The articulation screw 330 is rotationally fixedwith respect to the outer tube 310 by the nubs 334. As a result, thearticulation screw 330 can only move longitudinally as the articulationknob 332 is rotated about the articulation screw 330. Therefore,rotation of the articulation knob 322 in a first direction causes themovement of the articulation screw 330 in distal direction and rotationof the articulation knob 322 in a second direction causes the movementof the articulation screw 330 in proximal direction.

Axial movement of the articulation screw 330 causes the nubs 334 toreact against the articulation plunger 340 to cause longitudinalmovement of the articulation plunger 340 in the same direction. Movementof the articulation plunger 340 causes longitudinal movement of theshaft 350 and, in turn, longitudinal movement of the rack 360.

As discussed above, the first gear 420 is operatively connected with thelinear teeth 368 of the rack 360. With specific reference to FIGS. 17and 18, as the rack 360 is forced to move proximally, the first gear 420is rotated in a first direction causing the second gear 430 to berotated in a second direction. The second gear 430 causes the third gear440 to be rotated in the same direction as the first gear 420. The thirdgear 440 reacts against the geared segments 516 causing the secondtubular member 302 to pivot about the pivot ‘Z’ axis.

As seen in FIGS. 1-6, end effector 500 is in the form of a surgical clipapplier and is configured to support a clip cartridge 550. As seen inFIG. 27, clip cartridge 550 has a housing or base portion 560 and acover 590. With reference to FIG. 28, the housing 560 includes aproximal portion 561 a and a distal portion 561 b. The proximal portion561 a of housing 560 is cylindrical in shape and defines a longitudinalpassageway 562 therethrough. The longitudinal passageway 562 isco-axially located with the second longitudinal ‘X2’ axis andtransitions, as seen in FIGS. 22 and 23, from a larger cylindricalportion 562 a of the passageway 562, sized to accept the cylindricaldistal portion 522 of the knuckle 510, to a narrower or smaller portion562 b that is co-axially located with the center lumen 518 of theknuckle 510.

Now referring to FIGS. 22-23 and 27-28, the proximal portion 561 a ofthe housing 560 also defines a pair of parallel pinholes 563 locateddistally from the proximal end 560 a of the proximal portion 561 a. Thepair of pinholes 563 are aligned off-center, such that each of the pairof pinholes 563 creates a single passageway through the proximal portion561 a to extend into and through the larger cylindrical portion 562 a ofthe longitudinal passageway 562. Each hole 563 is sized to accept a pin586 therein to cause a friction or interference fit of the pin 586within the pinhole 563. Each of the pair of the pinholes 563 is locatedto position the pins 586 with the circular channel 520 of the knuckle510. As a result, the clip cartridge 550 is longitudinally restrained tothe knuckle 510 by the pins 586, while allowing the clip cartridge 550to rotate about the knuckle 510.

As seen in FIG. 28, the distal portion 561 b of the housing 560 is asemi-cylindrical structure that extends distally from a perpendicularsurface 564 of the proximal portion 561 a. With reference to FIG. 28,the semi-cylindrical distal portion 561 b has a pair of horizontal walls565 that extend partially along the distal portion 561 b, a firstrecessed surface 567, and a second recessed surface 568 that define alongitudinally extending recess 566 along the distal portion 561 b ofthe housing 560, between the pair of horizontal walls 565. A pair ofinward projection locks 569 extend into the longitudinally extendingrecess 566 along the first recessed surface 567 with one projection lockextending inward from each of the horizontal walls 565. A spring slot570 is defined longitudinally along the second recessed surface 568 at alocation distal of spring slot 570. A horizontal recess 571 is definedradially along the second recessed surface 568 at a location distal ofspring slot 570. Two stops 572 project from the second recess surface568 along the distal end 560 b and define a pair of longitudinalopenings 574 a, 574 b between the horizontal walls 565 and the stops572, and a distal opening 573 between the two stops 572. The distalportion 561 b of the housing 560 is shaped and sized to mate with thecover 590.

As shown in FIG. 27, the clip cartridge 550 includes a plurality orseries of clips or fasteners 580, a cam spring 600, a cam plate 610, ajaw structure 620, a block member 640, a feed bar 650, a clip carrier660, a clip follower 670, and a follower spring 680, between the housing560 and the cover 590.

The plurality of surgical clips 580 are retained within the clipcartridge 550 for application to tissue. As shown in FIG. 27A, each clip580 has a pair of legs 582 a, 582 b extending from a backspan 581 anddefines a clip axis ‘W’ extending substantially parallel with the pairof legs 582 a, 582 b. The clips 580 are located adjacent to one anotherto form an angled stack. With reference to FIGS. 42 and 43, the seriesof fasteners or clips 580 are arranged within the clip cartridge 550 toform an angle of between, but not including, 0° and 90° with the secondlongitudinal ‘X2’ axis. The series of clips 580 are stacked in or at anangle with respect to the second longitudinal ‘X2’ axis and extend alongin an offset parallel fashion with the second longitudinal X2′ axis. Theshape of the clip 580 may be U-shaped, V-shaped, or some other shape.

As seen in FIGS. 48-51, clip cartridge 550 includes a jaw closuremechanism 532 including the camming plate 610, which is connected withthe drive assembly 220 through the block member 640 to provide anapproximating force to the jaw structure 620.

With reference to FIGS. 27 and 29, the cam plate 610 defines a proximalportion 610 c and a camming or distal portion 610 d. A dog bone shapedaperture 611 is defined in the proximal portion 610 c and a cammingaperture 614 is defined in the camming portion 610 d. The cam plate 610has a finger 612 that extends perpendicularly to a top/bottom surfacethereof and a pair of stops 613 extending outward from the cammingportion 610 c along a side edge thereof.

The camming aperture 614 is substantially “V” shaped. The “V” shapedcamming aperture 614 defines a protrusion or separator 615 extendinginto the center of the aperture and a pair of camming surfaces 616 alongthe outer edges of the aperture. With reference to FIGS. 30 and 49-51,the camming aperture 614 mates with a pair of posts 621 that extendvertically from the jaw structure 620. Each post 621 includes a head 622that acts to secure the cam plate 610 and the jaw structure 620 togetherto maintain contact between the two components.

With reference to FIG. 37, cam plate 610 is located along the secondrecessed surface 568 of housing 560. The stops 613 of cam plate 610extend radially outward through the longitudinal openings 574 a, 574 bof housing 560 to limit longitudinal movement of the cam plate 610 tothe length of openings 574 a, 574 b. The proximal portion 610 c of theearn plate 610 is sized to fit into the longitudinal extending recess566 of the housing 560. When cam plate 610 is at a distal-most positionrelative to housing 560, a gap 575 is formed between the proximal end610 a of the cam plate 610 and the second recessed surface 567. Thefinger 612 is sized to be positioned within the spring slot 570 (FIG.28) of the housing 560. In use, longitudinal movement of the cammingplate 610 moves the cam aperture 614 relative to the posts 621 of jawstructure 620.

With reference to FIG. 38, a cam spring 600 is located within the springslot 570 of the housing 560 such that the finger 612 of the cam plate610 is disposed distal of cam spring 600.

With reference to FIGS. 27 and 30, the jaw structure 620 includes alocking tab 623, a pair of legs 625, and a pair of jaws 626. A pair oflock recesses 628 is defined between the locking tab 623 and the pair oflegs 625. The lock recesses 628 extend inward from side edges thereof toform a pair of locking shoulders 624. With reference to FIG. 36, thelocking recesses 628 act to secure the jaw structure 620 along the firstrecessed surface 567 of the housing 560, by providing space for theinward projecting locks 569. The inward projecting locks 569 act uponthe locking block 623 and the locking shoulders 624 to preventlongitudinal movement of the jaw structure 620 with respect to thehousing 560.

Each of the pair of legs 625 extends proximally from the respectivelocking shoulder 624 parallel with the second longitudinal ‘X2’ axis.The pair of jaws 626 is formed at the distal ends of the legs 625 andincludes a first jaw 626 a and a second jaw 626 b. Each jaw 626 extendsat an angle from the respective leg 635 to form an angle with the secondlongitudinal ‘X2’ axis. The clip axis ‘W’ of each clip 580 issubstantially parallel to a longitudinal axis of each of the first andsecond jaws 526 a, 526 b. Each jaw 626 defines a channel 627 along aninner section that is sized to accept a portion of the clip leg 582 a,582 b therein. One of the clip legs 582 a, 582 b is retained in thechannel 627 of the first jaw 626 a and the other clip leg 582 a, 582 bis retained in the channel 627 of the second jaw 626 h.

The jaw assembly or structure 620 is supported on and extends distallyfrom between the cover 590 and the housing 560. The jaw structure 620includes a first jaw 626 a and a second jaw 626 b that are moveablebetween a spaced apart position and an approximated position.

Referring to FIGS. 27 and 31, the movement of the cam plate 614 isprovided by the block member 640. With reference to FIG. 31, the blockmember 640 includes a pair of rails 644 extending from a surfacethereof, and a finger 642 extending from a surface opposite rails 644 ata location proximate a distal end 640 b of the block member 640. Thefinger 642 is sized to extend between the jaw legs 624, 625 and into thedog bone shaped aperture 611 of the camming plate 610.

With reference to FIGS. 31 and 44-45, a proximal end 640 a of the blockmember 640 is connected with the distal end 224 b of the drive cable224. As a result, advancement or retraction of the drive cable 224advances or retracts, respectively, the block member 640 along thesecond longitudinal ‘X2’ axis. Proximal movement or retraction of theblock member 640 will cause the finger 642 thereof to abut a proximalend 611 a of the dog bone shaped aperture 611 of camming plate 610 andwill in turn pull the camming plate 610 proximally. In a proximalposition, as seen in FIGS. 49 and 50, the cam aperture 614 presents theseparator 615 of camming plate 610, having a tapered end 615 a, betweenthe posts 621 of jaw structure 620 to separate the posts 621 and to openthe jaws 626.

Meanwhile, distal movement or advancement of the block member 640 willcause the finger 642 to abut a distal end 611 b of the dog bone shapedaperture 611 of camming plate 610 and will in turn push the cammingplate 610 distally. In a distal position, as seen in FIG. 51, thecamming surfaces 616, of cam aperture 614 of camming plate 610, forcethe posts 621 of the jaw structure 620 together to close the jaws 626. Alongitudinal length of the finger 642 is less than a length of the dogbone shaped aperture 611 to thereby allow the finger 642 of block member640 to move a predetermined distance before engaging and moving thecamming plate 610.

With reference to FIGS. 27 and 32, a feed bar 650 is provided forlongitudinal movement relative to cover 590 in order to advanceindividual clips 580 into jaws 626. As seen in FIG. 32, to facilitatethe insertion of the clip 580 into jaws 626, feed bar 650 is providedwith the pusher 652 at its distal end 650 b, which is configured toadvance an individual clip 580 out of the stack of clips 580 and intojaws 626.

The pusher 652 is sized and shaped to selectively engage/move (i.e.,distally advance) a distal-most clip “C1” (FIGS. 42 and 43) of the clips580 into the jaws 626. The feed bar defines a pair of recess 654 a, 654b along each side edge thereof that are sized and shaped to accept therails 644 a, 644 b of the block member 640 to mate the feed bar 650 andthe block member 640. Turning to FIGS. 44-48, it is understood that amovement of the block member 640 causes a movement of the feed bar 650in the same direction and in the same magnitude.

With reference to FIGS. 27 and 39-41, the feed bar 650 is slidablydisposed under the clip carrier 660. The clip carrier 660 is shaped andsized to retain the plurality of surgical clips 580 thereon. It shouldbe noted that clip carrier 660 and jaw structure 620 do not movelongitudinally relative to housing 560.

Referring to FIG. 33, the clip carrier 660 includes a distal pair ofslots 664 sized and shaped to receive the pusher 652 of feed bar 650therein. The clip carrier 660 is formed with a ‘hat’ shaped transversecross-sectional profile, consisting of a center platform 667, twovertical walls 666 projecting downward from the center platform 667, anda horizontal wall 665 projecting outward from each of the vertical walls666. Each of the horizontal walls 665 includes two longitudinally spacedretainers 661 that project upward along an outside edge. Each of theretainers 661 defines an opening 662 therethrough. A ramp section 668about a distal end 660 b allows the center platform 667 to be shorterthan the horizontal walls 665.

As shown in FIG. 40, a proximal end 660 a of the clip carrier 660 islocated against the perpendicular surface 564 of the housing 560 and thehorizontal walls 665 sit upon the horizontal walls 565 of the housing560. The ramp section 668 extends the clip carrier 660 partially over aflared out section 629 of the legs 625 of the jaw structure 620. Theramp section 668 forms substantially the same angle with respect to thesecond longitudinal ‘X2’ axis as the jaws 626.

With reference to FIGS. 27, 34, and 40, the clip follower 670 sits ontop of the clip carrier 660. As shown in FIG. 34, the clip follower 670includes an abutment surface 672 for engagement with the stack of clips580 and includes two arms 674 a, 674 b for engagement about the clipcarrier 660. The clip follower 670 includes a proximally extending post676 sized to fit inside of follower spring 680. With reference to FIG.42, the clip follower 670 is positioned behind the stack of clips 580 onthe clip carrier 660 to advance the stack of clips 580 through surgicalclip applier 100 as the distal-most clip is fired.

The clip follower 670 is biased distally by the follower spring 680 tourge the stack of clips 580 distally along the clip carrier 660. Thecover 590 overlies the clip carrier 660 and is configured to retain andguide advancement of the follower 670, the follower spring 680, and thestack of clips 580 therein.

As seen in FIGS. 27 and 35, the cover 590 of clip cartridge 550 has asubstantially semi-cylindrical body 591 and a nose 592. Two pairs ofsecuring protrusions 593 extend radially outward along each side of thesemi-cylindrical body 591 of cover 590. Each securing protrusion 593 issized and shaped to fit into and project through the openings 662 in theretainers 661 of the clip carrier 660. The cover 590 defines alongitudinal passage 595 therealong.

With reference to FIG. 45, the clip carrier 660 forms an elongated clipchannel with the inner surface of the longitudinal passage 595 of thecover 590 for retaining the plurality of clips 580, as shown in stackedmanner above the clip carrier 660 in FIGS. 40-43. To direct the clips580 traversing along the clip channel and into the jaws 626, a rampedinner surface 596 is provided at a distal end 590 b of cover 590 alongthe nose 592 to assist in directing surgical clips 580 into jaws 626.The proximal end 590 a of cover 590 is shaped to abut the perpendicularsurface 564 of the housing 560.

With reference to FIGS. 44-48, the operation of the clip cartridge 550will now be discussed. Initially, jaws 626 are placed about a vessel“V.” As seen in FIG. 44, actuation of the trigger 208 (see FIG. 5A)causes distal movement of the drive assembly 220 (see FIG. 5A) and driverod 222, represented by the direction arrow ‘a’. The distal movement ofdrive rod 222 causes distal advancement of drive cable 224 which in turncauses the advancement of the block member 640, represented by thedirection arrow ‘b’. Referring to FIG. 45, the distal movement of theblock member 640 causes a distal advancement of the feed bar 650,represented by the direction arrow ‘c’. As the block member 640 is moveddistally, the finger 642 thereof abuts against a reduced width portionof the dog bone shaped recess 611 to force the feed bar 650 distally. Asthe feed bar 650 is advanced distally, the pusher 652 of feed bar 650forces a distal-most clip ‘C1’ distally and in-between the jaw members626, as illustrated by the direction arrow ‘d’ in FIG. 46. During afurther advancement of the block member 640, the finger 642 of the blockmember 640 travels along the dog bone shaped recess 611 of the cam plate610 thereby maintaining the cam plate 610 stationary in a distal-mostposition, as seen in FIGS. 40 and 50.

Referring to FIGS. 47 and 48, with distal-most clip “C1” loaded in jawmembers 626, retraction of the drive rod 222 as a result of a release oftrigger 208, represented by the direction arrow ‘g’, causes a retractionor a proximal movement of the block member 640 and of the pusher 652 offeed bar 650, as illustrated by direction arrow ‘e’. As the feed bar 650is returned to the initial or starting position, the pusher 652 isforced down toward the center of the clip cartridge 550 by a ramped edge653 of the pusher 652 riding across the next clip in the stack of clips580. Referring to FIG. 48, the ramped edge 653 also allows the pusher652 to be positioned under the clip carrier 660, while the block member640 continues to move proximally from the initial starting position,represented by the direction arrow ‘h’. As the block member 640 movesproximally from the initial starting position, the finger 642 abuts andacts against the reduced width portion of the dog bone shaped recess 611to force the cam plate 610 to move proximally, represented by thedirection arrow ‘i’. As the cam plate 610 moves proximally, the finger612 of the cam plate 610 moves proximally, represented by directionarrow ‘j’ to compress the cam spring 600, represented by the directionarrow ‘k’.

With reference to FIGS. 49-52, the funning of the clip ‘C1” about ablood vessel will now be discussed. The interconnected cam plate 610 andjaw structure 626, as discussed earlier is shown in FIG. 49. With thejaws 626, having a clip ‘C1’ loaded therein and being placed about theblood vessel, the cam plate 610 is forced proximally by the proximallymoving block member 640 to cause the camming surface 616 (see FIG. 27)of jaws 626 to act against the posts 621 of the jaw structure 626. Asthe camming surface 616 of camming aperture 614 abuts each of the posts621 of the jaw structure 626, the posts 621 are forced together to formthe clip ‘C1’ about the blood vessel, as illustrated in FIG. 52.

As the trigger 208 continues to open to withdraw drive rod 222, blockmember 640 is further pulled in the proximal direction until finger 642thereof is pulled through the reduced width portion of the dog boneshaped recess 611 of the cam plate 610 at which time cam spring 600 ispermitted to expand and act on finger 612 of cam plate 610 to move camplate 610 distally and open jaw structure 626.

In this manner, a single complete stroke of trigger 208 results in afeeding of a clip “C1” into the jaws 626 and a forming of the loadedclip by the jaws 626. Such a firing sequence can be accomplished withthe second longitudinal axis “X2” of the end effector 500 either axiallyaligned with or angled with respect to the first longitudinal axis “X1”of the first tubular member 302 of the shaft assembly 300.

It should be understood that the foregoing description is onlyillustrative of the present disclosure. Various alternatives andmodifications can be devised by those skilled in the art withoutdeparting from the disclosure. Accordingly, the present disclosure isintended to embrace all such alternatives, modifications, and variances.The embodiments described with reference to the attached drawing figuresare presented only to demonstrate certain examples of the disclosure.Other elements, steps, methods, and techniques that are insubstantiallydifferent from those described above and/or in the appended claims arealso intended to be within the scope of the disclosure.

What is claimed is:
 1. An end effector for operative connection to asurgical handle assembly including an axially reciprocatable driveassembly having a flexible drive cable operatively connected to the endeffector, the end effector comprising: a distal housing portion defininga proximal end, a distal end, and a longitudinal axis; a knuckle portionextending proximally from the proximal end of the distal housingportion, the knuckle portion being bifurcated into a first gearedportion and a second geared portion, the distal housing portion beingrotatably mounted to the knuckle portion to allow the distal housingportion to rotate about the longitudinal axis with respect to theknuckle portion; a proximal housing portion pivotably connected to theknuckle portion; a gear train supported in the proximal housing portion,the gear train including: a distal-most spur gear operatively engagedwith the first geared portion and the second geared portion of theknuckle portion; and a proximal-most spur gear supported in the proximalhousing portion and operatively connected to the distal-most spur gear;and a rack slidably supported in the proximal housing portion andoperatively engaged to the proximal-most spur gear; a jaw assemblysupported on the distal housing portion, the jaw assembly including afirst jaw and a second jaw extending distally from the distal housingportion and being movable between a spaced apart position and anapproximated position; a plurality of surgical clips loaded in thedistal housing portion in a partially stacked fashion; and a jaw closuremechanism disposed in the distal housing portion and operativelyassociated with the jaw assembly and the plurality of surgical clips,wherein a distal end of the flexible drive cable is connected to the jawclosure mechanism so as to transmit an operative force to the jawclosure mechanism when the longitudinal axis of the distal housingportion is either axially aligned or angled with respect to alongitudinal axis of the surgical handle; and wherein the jaw closuremechanism feeds a clip into the jaw assembly and forms the fed clip upona single complete stroke of the flexible drive cable.
 2. The endeffector according to claim 1, wherein the rack defines at least oneaxial row of gear teeth, and wherein the axial row of gear teeth isengaged with the proximal-most spur gear of the gear train.
 3. The endeffector according to claim 2, wherein axial displacement of the rackrelative to the proximal-most spur gear results in articulation of thedistal housing portion relative to the proximal housing portion.
 4. Theend effector according to claim 3, wherein the knuckle portion includesa pivot structure that defines a pivot axis.
 5. The end effectoraccording to claim 1, wherein the jaw closure mechanism provides anapproximating force to the first jaw and the second jaw to close the jawassembly, and an opening force to the first jaw and the second jaw toopen the jaw assembly.
 6. The end effector according to claim 5, whereinthe jaw closure mechanism includes a cam plate axially slidablysupported in the distal housing portion, wherein the cam plate includesa camming aperture formed therein, wherein the camming aperture has asubstantially “V” shaped profile, and wherein each of the first jaw andthe second jaw includes a post extending therefrom and into the cammingaperture of the cam plate; wherein movement of the cam plate proximallyrelative to the first jaw and the second jaw engages an edge of thecamming aperture against the posts of the first jaw and the second jawto approximate the first jaw and the second jaw.
 7. The end effectoraccording to claim 6, wherein the cam plate includes a protrusionextending distally into the camming aperture; wherein movement of thecam plate distally relative to the first jaw and the second jaw engagesthe protrusion of the camming aperture between the posts of the firstjaw and the second jaw to separate the first jaw and the second jaw. 8.The end effector according to claim 1, wherein the plurality of clipsare stacked in a non-collinear orientation with respect to the secondlongitudinal axis.
 9. The end effector according to claim 8, wherein thefirst jaw and the second jaw are angled with respect to the longitudinalaxis.
 10. The end effector according to claim 9, wherein each of theplurality of surgical clips has a pair of legs extending from abackspan, each of the plurality of surgical clips defining a clip axisextending in a direction substantially parallel to the pair of legs,each of the plurality of surgical clips being arranged within the baseportion to define an angle between the clip axis and the longitudinalaxis, each of the plurality of surgical clips being located adjacent toanother of the plurality of surgical clips to form a partiallyoverlapping stack.
 11. The end effector according to claim 10, wherein,when the plurality of clips are loaded in the distal housing portion,the clip axis is in a substantially parallel orientation to an angle oforientation of the first jaw and the second jaw.
 12. An articulatingsurgical clip applier, comprising: a handle assembly having a housingand a trigger, the handle assembly including an axially reciprocatabledrive assembly having a flexible drive cable operatively connected toand actuatable by the trigger; and an end effector operatively connectedto the handle assembly, the end effector comprising: a distal housingportion defining a proximal end, a distal end, and a longitudinal axis;a knuckle portion extending proximally from the proximal end of thedistal housing portion, the knuckle portion being bifurcated into afirst geared portion and a second geared portion, the distal housingportion being rotatably mounted to the knuckle portion to allow thedistal housing portion to rotate about the longitudinal axis withrespect to the knuckle portion; a proximal housing portion pivotablyconnected to the knuckle portion at a pivot axis, wherein the flexibledrive cable extends from the handle assembly to the distal housingportion of the end effector and across the pivot axis of the endeffector; a gear train supported in the proximal housing portion, thegear train including: a distal-most spur gear operatively engaged withthe first geared portion and the second geared portion of the knuckleportion; and a proximal-most spur gear supported in the proximal housingportion and operatively connected to the distal-most spur gear; and arack slidably supported in the proximal housing portion and operativelyengaged to the proximal-most spur gear; a jaw assembly supported on thedistal housing portion, the jaw assembly including a first jaw and asecond jaw extending distally from the distal housing portion and beingmovable between a spaced apart position and an approximated position; aplurality of surgical clips loaded in the distal housing portion in apartially stacked fashion; and a jaw closure mechanism disposed in thedistal housing portion and operatively associated with the jaw assemblyand the plurality of surgical clips, wherein a distal end of theflexible drive cable is connected to the jaw closure mechanism so as totransmit an operative force to the jaw closure mechanism when thelongitudinal axis of the distal housing portion is either axiallyaligned or angled with respect to a longitudinal axis of the handleassembly; and wherein the jaw closure mechanism feeds a clip into thejaw assembly and forms the fed clip upon a single complete stroke of theflexible drive cable.
 13. The surgical clip applier end effectoraccording to claim 12, wherein the rack of the end effector defines atleast one axial row of gear teeth, and wherein the axial row of gearteeth is engaged with the proximal-most spur gear of the gear train. 14.The surgical clip applier according to claim 13, wherein axialdisplacement of the rack of the end effector relative to theproximal-most spur gear results in articulation of the distal housingportion relative to the proximal housing portion.
 15. The surgical clipapplier according to claim 14, wherein the knuckle portion includes apivot structure that defines a pivot axis.
 16. The surgical clip applieraccording to claim 12, wherein the jaw closure mechanism of the endeffector provides an approximating force to the first jaw and the secondjaw to close the jaw assembly, and an opening force to the first jaw andthe second jaw to open the jaw assembly.
 17. The surgical clip applieraccording to claim 16, wherein the jaw closure mechanism of the endeffector includes a cam plate axially slidably supported in the distalhousing portion, wherein the cam plate includes a camming apertureformed therein, wherein the camming aperture has a substantially “V”shaped profile, and wherein each of the first jaw and the second jawincludes a post extending therefrom and into the camming aperture of thecam plate; wherein movement of the cam plate proximally relative to thefirst jaw and the second jaw engages an edge of the camming apertureagainst the posts of the first jaw and the second jaw to approximate thefirst jaw and the second jaw.
 18. The surgical clip applier according toclaim 16, wherein the cam plate of the end effector includes aprotrusion extending distally into the camming aperture; whereinmovement of the cam plate distally relative to the first jaw and thesecond jaw engages the protrusion of the camming aperture between theposts of the first jaw and the second jaw to separate the first jaw andthe second jaw.
 19. The surgical clip applier according to claim 12,wherein the plurality of clips of the end effector are stacked in anon-collinear orientation with respect to the second longitudinal axis.20. The surgical clip applier according to claim 19, wherein the firstjaw and the second jaw of the end effector are angled with respect tothe longitudinal axis.
 21. The surgical clip applier according to claim20, wherein each of the plurality of surgical clips of the end effectorhas a pair of legs extending from a backspan, each of the plurality ofsurgical clips defining a clip axis extending in a directionsubstantially parallel to the pair of legs, each of the plurality ofsurgical clips being arranged within the base portion to define an anglebetween the clip axis and the longitudinal axis, each of the pluralityof surgical clips being located adjacent to another of the plurality ofsurgical clips to form a partially overlapping stack.
 22. The surgicalclip applier according to claim 21, wherein, when the plurality of clipsare loaded in the distal housing portion, the clip axis is in asubstantially parallel orientation to an angle of orientation of thefirst jaw and the second jaw.